AccountId: 011433970860
ContactId: c18b6310-078a-4ca3-ac84-67e1dccac603
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 206300 ms
Total Talk Time (AGENT): 102127 ms
Total Talk Time (CUSTOMER): 78460 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/c18b6310-078a-4ca3-ac84-67e1dccac603_20250401T15:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh, yeah. First of all, I'm audible to you.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Can you hear my voice?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, so my name is [PII]. Last name initial is [PII]. Just calling you from a facility as I need to verify benefits for a member.
[AGENT][POSITIVE] Sure, I can check benefits for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] I do. It's 023.
[CUSTOMER][NEUTRAL] 26,720.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that, [PII]. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and are we needing to check inpatient or outpatient benefits.
[CUSTOMER][NEUTRAL] It's gonna be for outpatient office, MRI services.
[AGENT][NEUTRAL] Outpatient, OK.
[AGENT][NEUTRAL] Alright, and of course I will let you know verification of coverage is not a guarantee of payment for claims so office visits are not going to be covered under this policy. However, treatment received in office could be their outpatient benefit is $6600 per calendar year. If you'll give me one moment, I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] Yeah, just provide me the out of pocket deductibles as well.
[AGENT][NEUTRAL] OK, so of that 6600 she has used $133.64.
[CUSTOMER][NEUTRAL] Uh, sorry for that.
[AGENT][NEUTRAL] And this plan does not have a
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, sorry to, yeah, sorry to interrupt you. So are you saying that the 6600. Is this a general amount or it does count under individual in the deductible or out of pocket?
[AGENT][NEUTRAL] No, that's the, that is the total benefit amount we would pay per calendar year. There is no out of pocket or deductible for this plan.
[CUSTOMER][NEUTRAL] OK, that's.
[CUSTOMER][NEUTRAL] OK, just a second, let me update you as you said.
[CUSTOMER][NEUTRAL] OK, and no coinsurance as well that's uh it's a secondary medical policy, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] It's a Medicare or medical?
[AGENT][NEUTRAL] Medical
[CUSTOMER][NEUTRAL] Medical policy. Thank you for that. And as there no author operation required as well.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's correct. No authorization is required.
[CUSTOMER][NEUTRAL] OK. I got the information I wanted. May I know your name again with last name first initial?
[AGENT][NEUTRAL] Yes, my name is spelled [PII] Last initial is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, that's it. Thank you so much. What's gonna be the call reference?
[AGENT][NEUTRAL] Alright, yeah, thanks for calling APL uh reference number would just be my first name, last initial, and today's date.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you.
[AGENT][POSITIVE] Of course, thanks for calling EPO have a great rest of your day.